Ethelred Enterprises, LLC.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4923T Issued in TX

Legal business name

ETHELRED ENTERPRISES, LLC.

Practice address

614 N New Rd # 6035
Waco, TX 76710-6035

Phone

(254) 770-1338

Fax

(254) 770-1602

NPI assigned

Jul 18, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Courtney Cheyne Cobbs, OD

Title

Owner/Managing Member

Phone

(817) 408-7636

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245801600000",
    "number": "1154585180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 N NEW RD",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767106035",
            "telephone_number": "254-776-1338",
            "fax_number": "254-751-1312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 N NEW RD # 6035",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767106035",
            "telephone_number": "254-770-1338",
            "fax_number": "254-770-1602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHELRED ENTERPRISES, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-18",
        "last_updated": "2009-06-24",
        "status": "A",
        "authorized_official_last_name": "COBBS",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_middle_name": "CHEYNE",
        "authorized_official_title_or_position": "OWNER/MANAGING MEMBER",
        "authorized_official_telephone_number": "817-408-7636",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TX",
            "license": "4923T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYE MED",
            "identifier": "TX4923",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "181493101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Waco, TX
• Providers in Waco, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.